TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr knows that navigating private medical insurance in the UK can be complex. One of the most common questions we hear is about cover for pre-existing conditions. This guide provides a clear, comprehensive explanation for you.
Key takeaways
- What insurers classify as a 'pre-existing condition'.
- The difference between acute and chronic illnesses.
- How insurers assess your medical history (underwriting).
- Whether you can ever get cover for a past condition.
- The vital importance of being honest during your application.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr knows that navigating private medical insurance in the UK can be complex. One of the most common questions we hear is about cover for pre-existing conditions. This guide provides a clear, comprehensive explanation for you.
WeCovr explains how PMI handles pre-existing health issues in the UK
Private Medical Insurance (PMI) is designed to give you fast access to high-quality private healthcare for new, treatable medical conditions that arise after your policy begins. This is a crucial point. Standard UK private health cover is specifically for acute conditions, not for managing long-term chronic illnesses or treating health issues you already have.
This guide will break down everything you need to know, including:
- What insurers classify as a 'pre-existing condition'.
- The difference between acute and chronic illnesses.
- How insurers assess your medical history (underwriting).
- Whether you can ever get cover for a past condition.
- The vital importance of being honest during your application.
What is a Pre-Existing Condition in Health Insurance?
In the world of UK private health insurance, a "pre-existing condition" is any disease, illness, or injury for which you have experienced symptoms, received medication, sought advice, or undergone treatment before the start date of your policy.
It doesn't matter whether you received a formal diagnosis or not. If you had symptoms and discussed them with a GP, that counts. Insurers typically look at your medical history from the last five years, but this can vary.
Examples of Pre-Existing Conditions:
- Asthma diagnosed in childhood that you still use an inhaler for.
- Joint pain in your knee that you saw a physiotherapist for last year.
- High blood pressure for which you take daily medication.
- Anxiety or depression that you have received counselling or medication for.
- A skin lesion you had removed three years ago.
The key takeaway is that if the health issue existed in any form before your cover began, it is considered pre-existing.
The Critical Difference: Acute vs. Chronic Conditions
Understanding the distinction between acute and chronic conditions is fundamental to understanding how PMI works. Insurers build their policies around this difference.
| Feature | Acute Condition | Chronic Condition |
|---|---|---|
| Definition | An illness or injury that is short-lived and likely to respond quickly to treatment, leading to a full or near-full recovery. | A long-term condition that cannot be cured, only managed. It may require ongoing monitoring, medication, or check-ups. |
| Examples | • A broken arm • Appendicitis • Cataracts • A hernia • A curable infection | • Diabetes • Asthma • Arthritis • High blood pressure (hypertension) • Crohn's disease |
| PMI Coverage | This is what PMI is for. Policies are designed to cover the diagnosis and treatment of new acute conditions. | Generally not covered. The day-to-day management of chronic conditions is handled by the NHS. |
Important Note: Some policies may cover an acute flare-up of a chronic condition, but only if that chronic condition was not pre-existing and is eligible for cover under your policy terms. The long-term management of the underlying chronic illness itself remains excluded.
How Insurers Assess Your Health: The Two Types of Underwriting
When you apply for private health cover, the insurer needs to assess the risk you pose. This process is called underwriting. For individual PMI policies in the UK, there are two main methods.
1. Moratorium Underwriting
This is the most common and straightforward method.
- How it works: You don't have to complete a detailed medical questionnaire. Instead, the policy automatically excludes any medical condition you've had symptoms, treatment, or advice for in the five years before the policy starts.
- The "rolling" period: Here's the key part. If you then go for two continuous years on the policy without needing any treatment, medication, or advice for that specific pre-existing condition, it may become eligible for cover.
- Pros: Quick and easy to set up; less intrusive application process.
- Cons: There can be uncertainty. You might not know for sure if a condition is covered until you make a claim, which can lead to investigation and delays.
Example: Sarah's Knee Pain Sarah takes out a policy with moratorium underwriting. Three years ago, she had physiotherapy for a sore knee.
- For the first two years of her policy, any issues with that knee are excluded.
- She has no knee trouble during this time. No pain, no GP visits, no advice.
- After the two-year anniversary of her policy, her knee is now potentially eligible for cover should a new problem arise with it.
2. Full Medical Underwriting (FMU)
This method is more detailed but provides complete clarity from the outset.
- How it works: You complete a comprehensive health questionnaire as part of your application, declaring your full medical history. The insurer's underwriting team reviews your information and may contact your GP (with your permission).
- The outcome: The insurer then provides you with a policy document that explicitly lists any conditions or body parts that are permanently excluded from cover.
- Pros: You have complete certainty from day one. You know exactly what is and isn't covered.
- Cons: The application process takes longer and requires you to provide detailed personal health information.
Comparing Underwriting Methods
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick, no health forms | Longer, requires a full health questionnaire |
| Clarity on Cover | Can be uncertain until a claim is made | Clear and explicit from the start |
| Exclusions | Automatic 5-year look-back, potential to be covered after 2 claim-free years | Specific, named exclusions listed on your policy documents |
| Best For | People with a clean bill of health or those who prefer a quicker setup | People with a complex medical history who want absolute certainty |
An expert PMI broker, like WeCovr, can help you decide which underwriting method is best for your personal circumstances. We can talk you through the pros and cons based on your health history at no cost.
Can a Pre-Existing Condition Ever Be Covered?
This is the million-dollar question. While the general rule is "no," there are specific scenarios where cover might be possible.
-
Through a Moratorium Policy: As explained above, this is the most common path. If you remain completely symptom-free and require no advice or treatment for a condition for two full years after your policy starts, it may no longer be considered pre-existing.
-
On a Group Scheme (Workplace PMI): Some large corporate health insurance schemes offer 'Medical History Disregarded' (MHD) underwriting. This is the most comprehensive type of cover, as it ignores pre-existing conditions entirely. However, it is very expensive and rarely available on individual or small business policies.
-
Switching Insurers with CPME: If you already have private health insurance and want to switch providers, you can often do so on a 'Continued Personal Medical Exclusions' (CPME) basis. This means the new insurer will carry over the same exclusions you had on your old policy. You won't gain cover for pre-existing conditions, but you won't lose the cover you've already built up.
For the vast majority of people buying a new personal policy, any condition that existed in the five years prior will be excluded from day one.
The Dangers of Non-Disclosure: Always Be Honest
It can be tempting to omit a past health issue from your application, hoping it will go unnoticed. This is a major mistake.
Your insurance policy is a contract based on the principle of "utmost good faith." If you fail to declare something and later make a claim, the insurer has the right to:
- Refuse to pay your claim: This could leave you with an unexpected and potentially huge private medical bill.
- Cancel your policy: Your cover will be voided from the start, as if it never existed.
- Make it difficult to get insurance in the future: A cancelled policy due to non-disclosure can be a red flag for other insurers.
When in doubt, declare it. It is far better to have a condition formally excluded than to risk your entire policy.
The NHS: Your Partner in Health
It's vital to remember that having a pre-existing condition excluded from your PMI policy does not leave you without care. The UK's National Health Service (NHS) provides comprehensive care to all UK residents, free at the point of use.
Your PMI policy and the NHS are designed to work in partnership:
- The NHS will continue to manage your pre-existing and chronic conditions, provide GP services, and handle emergency care (A&E).
- Your PMI gives you a choice for new, eligible acute conditions, allowing you to bypass NHS waiting lists and access private facilities.
With NHS waiting lists in England involving over 7.5 million treatment pathways (according to NHS England data from 2024), having PMI provides valuable peace of mind and speedy access for new issues that may arise.
More Than Just Treatment: The Wellness Benefits of PMI
Modern private health insurance is about more than just treating illness; it's also about promoting and maintaining good health. Even if you have exclusions for pre-existing conditions, you can still get immense value from the wellness benefits included in many policies.
These often include:
- 24/7 Digital GP: Get a remote appointment with a GP via phone or video call, often within hours.
- Mental Health Support: Access to telephone counselling, therapy sessions, and wellbeing apps.
- Gym and Fitness Discounts: Reduced membership fees for popular gym chains and fitness trackers.
- Health and Wellbeing Advice: Access to experts on nutrition, sleep, and stress management.
At WeCovr, we go a step further. All our PMI clients receive complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, helping you take proactive control of your diet and health. Furthermore, our clients often receive discounts on other types of cover, like life or income protection insurance, when they take out a PMI policy with us.
How WeCovr Makes a Difference
Choosing the right private medical insurance policy when you have a history of health issues can feel daunting. This is where we come in. As an independent, FCA-authorised broker with high customer satisfaction ratings, WeCovr works for you, not the insurers.
Our expert advisors can:
- Listen to your needs and understand your medical history.
- Explain your options clearly, including the pros and cons of Moratorium vs. Full Medical Underwriting.
- Compare quotes from across the market to find the most suitable policy at a competitive price.
- Ensure you understand all the terms and exclusions before you commit.
Our service is provided at no extra cost to you. We handle the complexity so you can make a confident and informed decision.
Do I need to declare a medical condition I had over 5 years ago?
Is cancer considered a pre-existing condition?
Can I get private health cover if I have a chronic illness like diabetes or asthma?
Ready to explore your options for private health cover?
Let our friendly experts guide you. Get your free, no-obligation quote from WeCovr today and find the right cover for your needs.
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.
